Is Taking Blood Pressure Medications at Night Really Better?

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Blood pressure and chronotherapy does timing matter one of the ways to diagnose high blood pressure is with a 24-hour blood pressure monitor in healthy people nocturnal blood pressure dips by about 15 compared to daytime values patients who don’t have this bp drop at night often called non-zippers are at increased risk for cardiovascular mortality heart failure and

Stroke this has led many researchers to consider the issue of chronotherapy the idea that when you take a pill is as important or possibly more important than which pill you actually take most patients take their bp medications in the morning but blood pressure is supposed to decrease at night and switching some blood pressure medications from morning to bedtime

Makes intuitive sense the igea chronotherapy trial reported very large decreases in stroke mi and death with nighttime dosing of antihypertensives the results got a lot of media attention but commentators quickly pointed out problems with this study firstly the magnitude of the benefit was extremely large for a very small change in blood pressure even nighttime bp

Measurements showed only small differences between both groups meta-regression studies have suggested that even with a 10 point reduction in blood pressure one should expect around a 20 relative risk reduction in cardiovascular disease of stroke and all-cause mortality but the hygiena trial suggested that cardiovascular disease was nearly cut in half for a much

Smaller decrease in blood pressure second switching blood pressure medication from morning to night time reduced not just cardiovascular death but also total death i.e all-cause mortality why the timing of blood pressure medications should affect non-cardiovascular mortality to such a large degree is unclear and somewhat implausible finally important questions

About medical therapy really need to be decided by well-conducted randomized trials but critics have questioned whether the hygiena criminal therapy trial was actually randomized they point out that the word randomized was only used three times in the entire manuscript once to define the acronym probe and twice to refer to a previous study on the same subject

By the same authors these critiques and subsequent inquiries led the editors of the european heart journal to publish an expression of concern and the issue seems to be under investigation for now it’s unclear if the timing of blood pressure medication really affects clinical endpoints to any significant degree in studies such as hope and europa or medications

Were given at night researchers did observe a reduction in cardiovascular events but they were testing a medication versus a placebo not evening versus morning doses in the convince trial nighttime’s rapamyl calcium channel blocker did not improve cardiovascular outcomes compared to morning doses of hydrochlorothiazide or atenolone but again researchers were

Not comparing evening versus daytime doses of the same medication for now there is insufficient evidence to be certain that nighttime dosing of medication has much benefit but given that one in five americans with high blood pressure don’t know they have it and are not receiving any treatment for this very modifiable risk factor coronal therapy might be less

Important than whether patients are getting any therapy at all

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Is Taking Blood Pressure Medications at Night Really Better? By Medscape